Thomas Fysh’s research while affiliated with Royal Devon and Exeter NHS Foundation Trust and other places

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Publications (8)


Mean surface areas and spread of painted sides and control.
Standardised histogram (experimental surface areas divided by control mean).
Quantifying Potential Error in Painting Breast Excision Specimens
  • Article
  • Full-text available

January 2013

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53 Reads

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2 Citations

Thomas Fysh

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Alex Boddy

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Aim. When excision margins are close or involved following breast conserving surgery, many surgeons will attempt to reexcise the corresponding cavity margin. Margins are ascribed to breast specimens such that six faces are identifiable to the pathologist, a process that may be prone to error at several stages. Methods. An experimental model was designed according to stated criteria in order to answer the research question. Computer software was used to measure the surface areas of experimental surfaces to compare human-painted surfaces with experimental controls. Results. The variability of the hand-painted surfaces was considerable. Thirty percent of hand-painted surfaces were 20% larger or smaller than controls. The mean area of the last surface painted was significantly larger than controls (mean 58996 pixels versus 50096 pixels, CI 1477-16324, P = 0.014). By chance, each of the six volunteers chose to paint the deep surface last. Conclusion. This study is the first to attempt to quantify the extent of human error in marking imaginary boundaries on a breast excision model and suggests that humans do not make these judgements well, raising questions about the safety of targeting single margins at reexcision.

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CE-MRA showing occlusion of the left profunda femoris artery from its origin.
DSA showing flush occlusion of the right profunda femoris artery at its origin.
Occlusion of the Profunda Femoris Artery in Competitive Cyclists

April 2010

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319 Reads

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2 Citations

EJVES Extra

Symptomatic lower limb ischaemia in endurance athletes and competitive cyclists is usually due to iliac artery compression syndrome. We report the cases of two competitive cyclists who presented with thigh claudication, with no previous cardiovascular or thrombo-embolic risk factors. They both had normal conventional and sports exercise tests. Further investigations revealed flush occlusion of the profunda femoris artery, believed to be due to dissection. Both patients improved with graduated exercise. We recommend contrast-enhanced MRA as the investigation of choice for this previously unreported condition.


Citations (5)


... During the first three minutes, ABI in left lower limb falls, a hemodynamic result very different from that observed in the right lower disease (PAOD), and its normal value is greater than 0.9. The occurrence of a normal ABI value at rest does not rule out PAOD in cyclists 12,29,45 ; therefore, this test should be performed at submaximal or maximal effort to induce the appearance of the complaints that result from cycling 3,30,65 . For cyclists, the effort test is more reliable when performed in a cycle ergometer or cycle simulator (absolute distance, or Strandness test in French) than when the treadmill test is used, because the ergometer and simulators reproduce the C.I.A. common iliac artery; E.I.A.: external iliac artery; E.I.V.: external iliac vein; C.F.A.: common femoral artery; P.F.A.: profound femoral artery; P.A. popliteal artery; l left lower limb; r right lower limb; d. n. i. data not informed; y age of seven cyclists (2• r and 5• l ) ranged from 23 to 31 years; a age of sixteen cyclists ranged from 23 to 47 years; β age of five cyclists ranged from 23 to 34 years; p age of thirty-six cyclists (9• r , 20• l and 7• l,r ) ranged from 20 to 49 years; µ age of four cyclists ranged from 24 to 37 years; γ of twenty-five cyclists included in the study, there were twenty-seven cases, as two cyclists (1 man and 1 woman) were studied at two different time points and in contralateral limb to the one affected before: 15• l , ten men and five women -8• r , two men and six women, and 4• l,r , three men and one woman. ...

Reference:

Lower limb vascular dysfunction in cyclists
Occlusion of the Profunda Femoris Artery in Competitive Cyclists

EJVES Extra

... These include specimen flattening, which results in artifactual reduction of margin widths (a problem exacerbated by compression for specimen radiography); difficulties with specimen orientation and in distinguishing the boundaries between margins when applying ink; variation in extent and rigor of margin evaluation; and difficulties in the identification of the true margin of excision in cases in which there is tracking of ink into the specimen. [27][28][29][30] Given these limitations in margin evaluation, the panel questioned whether a margin of ink not touching tumor versus 1 mm was a reproducible or clinically meaningful difference. 31 ...

Quantifying Potential Error in Painting Breast Excision Specimens

... However, debates linger regarding the optimal institutional and organizational setup for talent identification and development in surgery. [15][16][17][18] Literature regarding talent identification and development in sports emphasizes the effect of institutional influences on individual performance. 7,[19][20][21][22] This domain emphasizes the transaction among affordances (opportunities for action) and how performers become attuned to perceive key variables that specify goal achievement. ...

Are Great Surgeons Born?
  • Citing Article
  • March 2012

Journal of Surgical Education

... When feedback is of poor quality, its utility is decreased [6]. The biggest cause of poor feedback is "feedback fatigue" [7], soliciting feedback so frequently that participation drops and the results are terse and prone to response bias. Additionally, overly vague or specific feedback has been shown to be less effective [6], as has exclusively positive or exclusively negative feedback [8]. ...

Feedback fatigue
  • Citing Article
  • December 2011

The Clinical Teacher